A Rare Case of Complicated Hepatic Hydrothorax

Abstract

We describe a rare case of a complicated hepatic hydrothorax in which the fluid grew Gram-positive bacteria (Staphylococcus aureus), indicating a spontaneous bacterial empyema (more recently noted as spontaneous bacterial pleuritis). A 51-year-old man with a history of alcoholism presented to the emergency room for fall and altered mental status but after initial investigation and imaging, he was found to have a hepatic hydrothorax - a rare complication seen in cirrhotic patients. It is a transudative pleural effusion, which is defined by accumulation of fluid in the pleural cavity in patients with decompensated liver cirrhosis but without cardiopulmonary and pleural diseases. The patient was originally diagnosed with hepatic encephalopathy secondary to decompensated cirrhosis. He underwent a thoracentesis and treated with conservative management, with initial improvement, but started decompensating after he was found to have methicillin sensitive Staphylococcus aureus bacteremia. Antibiotics were started but patient unfortunately deteriorated, including respiratory distress, and subsequently became intubated and transferred to the critical care unit, where he eventually expired.

Clin Infect Immun. 2022;7(1):27-30
doi: https://doi.org/10.14740/cii146